Abstract 14393: Characteristics of Patients Requiring Long Atrio-Ventricular Delay Setting After Cardiac Resynchronization Therapy
Background: While default settings of Atrio-Ventricular Delay (AVD) programmed at the implantation of cardiac resynchronization therapy (CRT) are adequate for many, a subset of patients demonstrates better echocardiographic (echo) hemodynamics with longer AVD. We aimed to identify features of patients potentially benefiting from long AVD settings.
Methods: 99 patients with echo-guided AV optimization by iterative method after CRT (total 180 optimization attempts) were examined. Long AVD was defined as a final sensed AVD of ≥160 and/or a final paced AVD of ≥ 180 ms. Echo response to CRT by reverse left ventricular (LV) remodeling at late echo (292 ± 287 days) and a combined endpoint of all cause mortality and heart failure (HF) hospitalization at 1 year were assessed.
Results: 59 patients were optimized to default AVD (Group 1) and 40 to long AVD (Group 2). There were no significant differences between groups in baseline characteristics except predominant male gender and longer intrinsic AVD in group 2 (Table). At the final optimization (179 ± 318 days), while LV volumes and ejection fraction were comparable between groups, group 2 showed a significantly larger left atrial volume, more advanced diastolic dysfunction, worse right ventricular dysfunction, and more cases of significant mitral and tricuspid regurgitations (Table). Echo response rate (63% vs 35%, p=0.001) and one year event free survival were lower in group 2 (Figure).
Conclusion: Optimal AVD may have prognostic value in CRT. In our cohort, patients requiring long AVD to optimize echo-LV fillings after CRT had longer intrinsic AVD, worse LV diastolic and RV systolic dysfunction, and progressed to worse outcomes.
- © 2012 by American Heart Association, Inc.